May 22, 2006

Rape as a Tool of War: Abortion Care Needs in Darfur

Raped women have to live with the threat of HIV/AIDS, with access to only minimal medical care in Darfur and in refugee camps in neighbouring Chad.

A colleague of mine brought this article to my attention. It’s in the latest issue of Forced Migration Review(May 2006), dealing with people trafficking. This is the in-house journal for the Refugee Studies Centre in Oxford. The whole issue can be downloaded as a PDF. If you get a chance, check out Abortion Care Needs in Darfur and Chad by Tamara Fetters. She is a researcher for Ipas, a non-governmental organization working to increase women’s ability to exercise their sexual and reproductive rights.

The writer examines why there is a lack of reproductive health services and treatment of complications that result from unsafe abortions or miscarriages in health facilities for refugees and those internally displaced.

The article states that violence against women in Darfur and in refugee camps in Chad are well-documented. These occur while women are foraging for water, fuel or animal fodder, or during imprisonment. There have also been cases of women being forced to submit to sex in exchange for ‘protection’ by police officers and male residents in the refugee camps.

In addition, Amnesty International reported that in armed conflicts that it investigated in 1999 and 2000, the torture of women was reported, most often in the form of sexual violence. Women and girls make up more than half of refugees in the world. These women are more vulnerable to rape and sexual violence. In addition, unaccompanied women and girls are often regarded as common sexual property in camps and may face forced prostitution as well as coercion into sex in exchange for food, documents or refugee status.

Rape is not an accident of war, or an incidental adjunct to armed conflict. Its widespread use in times of conflict reflects the unique terror it holds for women, the unique power it gives the rapist over his victim, and the unique contempt is displays for its victims. The use of rape in conflict reflects the inequalities women face in their everyday lives in peace time. Until governments take responsibility for their obligations to ensure equality, and end discrimination against women, rape will continue to be a favored weapon of the aggressor. – Amnesty International

Fetters reported that between October 2004 and February 2005, Medecins sans Frontieres (MSF) teams in West and South Darfur treated almost 500 women and girls who had been raped almost a third of whom had been multiply raped. These figures most likey represent only a fraction of cases, since most incidents go unreported. Women in conflict zones, refuse to report forced sex for fear of isolation, abandonment and stigma.

At the heart of Fetters’ article is how one in twenty rape cases will result in unwanted pregnancy. Many others result in desertion by husbands and health problems such as pelvic inflammatory disease, HIV and STDs. Psychological and physical trauma and malnutrition put rape victims at risk of miscarriage. Lack of access to health and contraceptive services cause women to seek unsafe abortions with dangerous complications rather than carry a child to term.

In Darfar, rape and sexual violence are used as tool of war by the Janjaweed militia. The UN, governments and NGOs working with refugees and IDPs are obliged to provide protection from sexual violence. They must ensure that health services can respond to the consequences of sexual violence, that women and girls are informed of their rights and that culturally appropriate treatment and counselling services is available to women who need it.

Abortion is legal in Chad and Sudan if it is a question of saving a woman’s life, protecting her health or when the pregnancy is the result of rape. However, these legal provisions in are unambiguous. Are a woman’s human rights violated if she is forced to carry to term an unwanted pregnancy resulting from rape?

The article examines how assessments of availability of reproductive health services for survivors of sexual violence in Darfur are seriously lacking. Using information from Human Rights Watch, Fetters found that only one in six agencies providing health services in the refugee camps in Chad offers emergency contraception, comprehensive treatment of sexually transmitted infections and post-exposure prophylaxis for the prevention of HIV transmission.

Access to safe abortion as an option for rape victims is not openly discussed in any health facility receiving international humanitarian assistance in Darfur, Chad or elsewhere. There has been little or no discussion of how to put WHO/UNHCR standards into practice in a field setting and health providers are left to use their own initiative to find out about local ‘safe’ abortion services.

Humanitarian agencies do not necessarily provide abortion services or accurate information for victims of rape in camp or IDP settings. Fetters argues that it is likely US government anti-abortion policies have contributed to reluctance to provide safe services.

Health providers on the field should be able to treat complications resulting from unsafe abortions on site. Performing a uterine evacuation to treat an unsafe abortion or miscarriag is a common surgical procedure. There is no need for women to suffer, die needlessly or endure more mental and physical trauma.

If we want to see changes in social or health policy, it must come from the top in donor and operational agencies. Continued denial of a woman’s right to have information about and access to a safe and legal termination of rape-induced pregnancy violates of international human rights treaties.